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Working with Health Plans

Friday, October 17, 2014

For many people with a new health insurance policy, or those who may be getting screened for the first time, speaking with their physician is only the first step in the screening process. Patients also should review their health plan coverage before the exam to understand what is covered and how their plan interacts with the new PPACA requirements.

Most commercial health benefit plans cannot charge out-of-pocket costs for colonoscopies. While these provisions may seem straightforward, questions remain.  For example, the preventive colorectal cancer screening is considered a covered benefit with no out-of-pocket expenses, but what if a polyp is found during the procedure? Would removal of a polyp during the routine screening also be covered?  For most commercial health plans, the U.S. Department of Labor has said that a colorectal cancer colonoscopy must be covered with no out-of-pocket cost.  It pays for patients to have this discussion with their physician and their health benefit plan representative before the screening to avoid health care coverage misunderstandings.

Preventing Colorectal Cancer

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